Ati Active Learning Template Therapeutic Procedure

The ATI Active Learning Template: Therapeutic Procedure is a structured tool designed to enhance nursing students' understanding and application of therapeutic procedures. This template encourages active learning by prompting students to think critically about the purpose, steps, patient education, and potential complications of various therapeutic procedures. By engaging with this template, students move beyond rote memorization and develop a deeper, more practical comprehension of patient care.

Understanding the ATI Active Learning Template

The Active Learning Template (ALT) is a cornerstone of the ATI (Assessment Technologies Institute) nursing education program. It's designed to facilitate active learning, critical thinking, and clinical judgment. The Therapeutic Procedure template, specifically, focuses on equipping students with the knowledge and skills necessary to perform and understand various clinical procedures effectively and safely. It's not just about knowing the steps; it's about understanding the why behind each step.

Key Components of the Therapeutic Procedure Template

The Therapeutic Procedure template typically includes the following sections, each designed to prompt specific critical thinking processes:

• Name of Procedure: Clearly identifies the therapeutic procedure being studied.
• Indication: Describes the conditions or circumstances in which the procedure is appropriate and beneficial for the patient.
• Contraindications: Lists the conditions or circumstances in which the procedure should not be performed because it could be harmful to the patient.
• Potential Complications: Outlines possible adverse effects or risks associated with the procedure and how to manage them.
• Nursing Interventions (Pre, Intra, Post): Details the specific actions the nurse should take before, during, and after the procedure to ensure patient safety and optimize outcomes.
• Client Education: Explains what the patient needs to know about the procedure, including its purpose, what to expect, and how to care for themselves afterward.
• Evaluation of Effectiveness: Describes how the nurse will assess whether the procedure was successful in achieving its intended outcome.

Using the ATI Template: A Step-by-Step Guide

Effectively using the ATI Active Learning Template requires a systematic approach. Here's a breakdown of how to complete each section, along with examples to illustrate the process.

1. Name of Procedure

• What to do: Clearly and accurately identify the therapeutic procedure. Be specific!
• Example: "Insertion of a Foley Catheter" (as opposed to simply "Catheterization")

2. Indication

• What to do: Explain the reasons why this procedure is being performed. Consider the specific medical conditions or patient needs that justify its use. Use medical terminology accurately.
• Example: "Urinary retention, accurate monitoring of urinary output in critically ill patients, management of urinary incontinence when other measures have failed, bladder decompression prior to surgery."

3. Contraindications

• What to do: Identify situations where the procedure would be harmful or inappropriate. Include patient conditions, allergies, or other factors that would preclude its use.
• Example: "Known allergy to latex (if using a latex catheter), acute urethral trauma, recent urological surgery, presence of urethral strictures."

4. Potential Complications

• What to do: Outline potential adverse effects or risks associated with the procedure. For each complication, describe signs and symptoms to watch for and appropriate nursing interventions.
• Example:
  • Infection (CAUTI - Catheter-Associated Urinary Tract Infection): Signs/Symptoms: Fever, chills, dysuria, flank pain, cloudy urine. Nursing Interventions: Monitor vital signs, obtain urine culture, administer antibiotics as prescribed, maintain sterile technique during catheter care.
  • Urethral Trauma: Signs/Symptoms: Bleeding, pain, hematuria. Nursing Interventions: Stop the procedure if significant resistance is met, notify the physician, monitor for further bleeding, provide pain relief.
  • Bladder Spasms: Signs/Symptoms: Abdominal cramping, urge to urinate despite catheter placement. Nursing Interventions: Administer antispasmodics as prescribed, ensure catheter is draining properly, provide reassurance to the patient.

5. Nursing Interventions (Pre, Intra, Post)

This section is broken down into three phases, each requiring detailed planning and action.

• Pre-Procedure:
  • What to do: Detail the steps taken before the procedure to prepare the patient and the environment. This includes assessment, equipment gathering, patient education, and ensuring proper consent.
  • Example:
    • Verify physician's order.
    • Gather necessary equipment (catheter kit, sterile gloves, antiseptic solution, lubricant, drainage bag).
    • Assess patient's allergies (especially latex).
    • Explain the procedure to the patient and answer any questions.
    • Provide privacy and ensure adequate lighting.
    • Position the patient appropriately (dorsal recumbent for females, supine for males).
• Intra-Procedure:
  • What to do: Describe the steps taken during the procedure to ensure safety, asepsis, and patient comfort.
  • Example:
    • Perform hand hygiene and don sterile gloves.
    • Clean the perineal area with antiseptic solution using sterile technique.
    • Insert the catheter gently into the urethra until urine flow is established.
    • Inflate the catheter balloon with the prescribed amount of sterile water.
    • Secure the catheter to the patient's thigh to prevent traction.
    • Attach the drainage bag to the bed frame, ensuring it is below the level of the bladder.
• Post-Procedure:
  • What to do: Outline the actions taken after the procedure to monitor the patient, prevent complications, and document the procedure.
  • Example:
    • Assess the patient's comfort level and provide pain relief as needed.
    • Monitor urine output for color, clarity, and amount.
    • Assess for signs and symptoms of infection.
    • Provide catheter care per hospital policy.
    • Educate the patient on catheter care and signs of complications to report.
    • Document the procedure in the patient's chart, including the date, time, catheter size, urine output, and patient's response.

6. Client Education

• What to do: Explain what the patient needs to know about the procedure, its purpose, what to expect during and after, and how to care for themselves at home (if applicable). Tailor the education to the patient's understanding level.
• Example:
  • "I'm going to insert a small tube into your bladder to help drain your urine. You may feel some pressure, but it shouldn't be painful. It's important to keep the area around the catheter clean to prevent infection. If you notice any redness, swelling, pain, or fever, please let us know immediately."
  • "After you go home, be sure to drink plenty of fluids. You should also empty the drainage bag regularly and keep it below the level of your bladder. We will give you instructions on how to clean the catheter insertion site. Contact your doctor if you experience any problems."

7. Evaluation of Effectiveness

• What to do: Describe how you will determine if the procedure achieved its desired outcome. What specific indicators will you monitor?
• Example:
  • "Evaluate the effectiveness of the Foley catheter insertion by monitoring urine output (at least 30 mL/hour), assessing for resolution of urinary retention, and observing for absence of bladder distention. Also, monitor for signs and symptoms of CAUTI. The catheter is effective if the patient is comfortable, urinary retention is relieved, and there are no signs of infection."

Benefits of Using the ATI Active Learning Template

The ATI Active Learning Template offers numerous benefits for nursing students:

• Promotes Active Learning: Encourages students to actively engage with the material, rather than passively memorizing facts.
• Develops Critical Thinking: Prompts students to think critically about the rationale behind each step of the procedure and potential complications.
• Enhances Clinical Judgment: Helps students develop the ability to make sound clinical judgments based on a thorough understanding of the procedure.
• Improves Patient Safety: Equips students with the knowledge and skills necessary to perform procedures safely and effectively, minimizing the risk of complications.
• Facilitates Knowledge Retention: Active learning strategies improve knowledge retention and long-term recall.
• Prepares for Clinical Practice: Provides a structured framework for understanding and applying therapeutic procedures in real-world clinical settings.

Example: Applying the Template to Nasogastric Tube Insertion

Let's walk through another example, this time focusing on the insertion of a nasogastric (NG) tube.

Name of Procedure: Nasogastric Tube Insertion

Indication

• Gastric decompression (e.g., bowel obstruction, ileus)
• Gastric lavage (e.g., overdose, poisoning)
• Administration of medications or feedings
• Obtaining gastric specimens for analysis

Contraindications

• Significant facial trauma or basilar skull fracture
• Esophageal strictures or varices
• Recent nasal or esophageal surgery
• Altered mental status with inability to protect airway (relative contraindication)

Potential Complications

• Aspiration: Signs/Symptoms: Coughing, choking, respiratory distress, decreased oxygen saturation. Nursing Interventions: Position patient in high Fowler's position, verify tube placement before feeding or medication administration, monitor respiratory status.
• Nasal or Esophageal Trauma: Signs/Symptoms: Bleeding, pain, perforation. Nursing Interventions: Use lubrication, insert tube gently, avoid forcing the tube, assess for signs of bleeding.
• Incorrect Placement (e.g., in lungs): Signs/Symptoms: Respiratory distress, inability to speak, coughing. Nursing Interventions: Verify tube placement with X-ray before initial use, aspirate gastric contents and check pH, auscultate for air insufflation in the stomach.
• Electrolyte Imbalance: Signs/Symptoms: Weakness, fatigue, muscle cramps, cardiac arrhythmias. Nursing Interventions: Monitor electrolyte levels, administer electrolyte replacements as prescribed.

Nursing Interventions (Pre, Intra, Post)

• Pre-Procedure:
  • Verify physician's order.
  • Gather necessary equipment (NG tube, lubricant, tape, emesis basin, stethoscope, pH indicator strip, irrigation syringe, suction equipment).
  • Assess patient's nasal passages for patency and any obstructions.
  • Explain the procedure to the patient and answer any questions.
  • Position patient in high Fowler's position.
  • Establish a signal for the patient to indicate distress (e.g., raising a hand).
• Intra-Procedure:
  • Perform hand hygiene and don gloves.
  • Measure the length of the tube from the tip of the nose to the earlobe to the xiphoid process.
  • Lubricate the tip of the tube.
  • Instruct the patient to tilt their head back slightly.
  • Gently insert the tube into the nostril, advancing it slowly along the floor of the nasal passage.
  • When the tube reaches the nasopharynx, instruct the patient to flex their head forward and swallow.
  • Advance the tube 1-2 inches with each swallow.
  • If resistance is met, rotate the tube slightly and try again. Do not force the tube.
  • Once the tube is inserted to the predetermined length, verify placement using multiple methods:
    • Aspirate gastric contents and check pH (should be acidic, typically < 5).
    • Auscultate over the stomach while injecting 10-20 mL of air.
    • Obtain an X-ray to confirm placement (required before initial use for feeding).
  • Secure the tube to the patient's nose with tape.
• Post-Procedure:
  • Connect the tube to suction or feeding equipment as prescribed.
  • Monitor patient's respiratory status and comfort level.
  • Provide oral hygiene regularly.
  • Assess for signs and symptoms of complications (e.g., aspiration, nasal irritation).
  • Document the procedure in the patient's chart, including the date, time, tube size, method of placement verification, and patient's response.

Client Education

• "I'm going to insert a small tube through your nose into your stomach. This will help remove fluids or deliver medication/nutrition. You may feel some discomfort or gagging during the procedure, but it's important to try and relax and swallow. Let me know if you feel any pain or difficulty breathing."
• "After the tube is in place, it's important to keep your head elevated to prevent aspiration. We will provide regular oral hygiene to keep your mouth moist. Let us know if you experience any nasal irritation or discomfort."

Evaluation of Effectiveness

• Evaluate the effectiveness of the NG tube insertion by assessing for relief of gastric distention, successful removal of gastric contents, or appropriate delivery of medications/feedings. Monitor for signs and symptoms of complications, such as aspiration or nasal trauma. The NG tube is effective if the patient's condition improves, and there are no adverse effects from the procedure.

Common Mistakes to Avoid When Using the Template

• Superficial Answers: Don't just provide basic definitions. Delve deeper into the rationale and implications of each section.
• Lack of Specificity: Be specific in your descriptions of indications, contraindications, complications, and nursing interventions.
• Ignoring Contraindications: Understanding when not to perform a procedure is just as important as knowing how to perform it.
• Poorly Defined Nursing Interventions: Clearly outline the steps the nurse should take before, during, and after the procedure.
• Neglecting Client Education: Patient education is crucial for promoting adherence and preventing complications.
• Failing to Evaluate Effectiveness: Determine how you will assess whether the procedure achieved its intended outcome.
• Copying and Pasting: Avoid simply copying information from textbooks or online resources. Use your own words to demonstrate understanding.

Tips for Maximizing the Template's Effectiveness

• Start Early: Don't wait until the last minute to complete the template.
• Use Multiple Resources: Consult textbooks, journal articles, and reputable online resources to gather information.
• Discuss with Peers: Collaborate with classmates to share insights and perspectives.
• Seek Guidance from Instructors: Don't hesitate to ask your instructors for clarification or feedback.
• Relate to Clinical Experiences: Connect the information in the template to your experiences in clinical practice.
• Focus on Understanding, Not Memorization: Aim to understand the underlying principles and rationale behind each procedure.
• Review Regularly: Review the completed templates regularly to reinforce your knowledge.

The ATI Active Learning Template as a Bridge to Competent Practice

The ATI Active Learning Template: Therapeutic Procedure is more than just a worksheet; it's a powerful tool for developing the critical thinking skills and clinical judgment necessary for safe and effective nursing practice. By engaging with the template in a thoughtful and systematic way, nursing students can move beyond rote memorization and develop a deeper understanding of the why behind each procedure. This ultimately translates to improved patient outcomes and a more confident and competent nursing workforce. By mastering the use of this template, future nurses are well-equipped to provide high-quality, patient-centered care in a dynamic and challenging healthcare environment.